This blog looks at the works performed by an oculoplastic surgeon. The blog discusses the common eyelid conditions that an oculoplastic surgeon dealed with on daily basis with real patient photos (consent obtained).

AT 18, she was deemed beautiful enough to be crowned Miss Malaysia World in
2003.

Today, at only 26, Ms Leng Yein has undergone almost 10 cosmetic procedures -
including a nose job, adding dimples and enhancing her breasts - to improve her
looks.

And she has caused a stir on both sides of the Causeway by raving about her
procedures and posting pre- and post-surgery pictures on her Facebook page,
which has 110,000-plus fans.

Her posts have been polarising, with young women looking to her as their
go-to cosmetic surgery agony aunt.

But some parents worry that she is the wrong role model for young,
impressionable females.

A 21-year-old undergrad here, who wanted to be known only as Wendy, said:
"I've been thinking of making my nose narrower and sharper since I was teased in
secondary school.

"She not only posts pictures of her face just after surgery for us to see,
but also says that it's painful but she can tolerate it.

"I admire her. I want to be like her - dare to change what I'm not satisfied
with myself, regardless of the pain."

Though her parents are against the idea, Wendy is considering a trip to South
Korea to have her nose done.

She said: "I want to do what I feel will make me happy, like her (Ms
Leng)."

But Madam Lorna Neo, 44, a secretary and mother of two daughters aged 18 and
19, felt that it was "terrible" that young women are looking up to Ms Leng.

"She has gone through so many surgical procedures that she no longer looks
like the person she was born as. I definitely don't want my daughters to think
what she's doing is okay," she added.

Mrs Julianne Lee, a 50-year-old housewife, said: "She may say she's happy and
confident, but what's the use of being happy with something that is not natural,
that didn't originally belong on her?"

The mother of two - her son, 25, is a model and daughter, 19, a student - was
also concerned about botched procedures, asking: "What happens when the surgery
goes wrong?"

Ms Leng, who now owns a boutique, a fashion accessories shop, a nail and
beauty salon, a tattoo parlour and a restaurant in Kuala Lumpur, Malaysia, was
21 when she first had cosmetic surgery - a nose job - in 2006.

But she had been thinking of going under the knife since 2003. That year was
notable for two things - she won the Miss Pahang and Miss Malaysia World titles,
and her boyfriend dumped her for another woman.

Proud to be plasticClick on thumbnail
to view (Photos: The Straits Times)

Left her for prettier girl

Ms Leng, who got married in October last year, told The New Paper in
Singapore recently: "When my first love left me for a prettier girl, I
thought... just because she's hot, you left me. One day, I want to be hotter
than her."

But her first procedure, done in Beijing, China, which saw an implant
inserted up the length of her nose, was botched.

She noticed that the implant was shiny in photographs as it overstretched the
skin on her nose, but she did not correct it until much later. (See report on
facing page.)

Since then, Ms Leng has had five other procedures and a few more corrective
ones done.

With each procedure, she gets a shot of self-confidence, she said.

But she sparked controversy when she came out about her plastic beauty
earlier this year.

It was reported in the media, and her supporters thanked her on her blog and
her Facebook page for leading the way in making plastic surgery less taboo.

On her blog, reader Li Lin wrote: "Leng Yein jie jie (Mandarin for sister), I
am proud of you! You dare to show what's in you, what's with you and what's
about you.

"You taught me on how to love myself, too. I really admire you, your courage,
the way you live and almost everything."

But one of Ms Leng's detractors criticised her for her openness.

He wrote: "She is shameless... bold and is probably the only celebrity (in)
Malaysia (who has gone) public (about her) multiple plastic surgeries."

Others rubbished her blog posts and called her "disgusting" and
"plastic".

Ms Leng told TNP that she is proud of herself and has no regrets.

She described how her friends had insisted their features were "original"
even after she noticed their sharper jawline and other facial changes.

She said she did not want to deny her plastic surgery journey as she did not
want to be like her friends.

She feels that if they had been open about their surgery and advised her on
which clinics and doctors to go to and what risks she would be facing, she would
not have made the mistake of having her first procedure done in Beijing.

She said this is the reason she advises young women now - so they can make
informed choices on where to get plastic surgery done.

And she will not let the opinions of others bring her down, saying: "Haters
will hate everything they can find about me."

As for her extensive plastic surgery, she said: "I don't care whether it's
natural beauty or not. "When you curl your hair and perm your hair, (it's) also
not natural. Like push-up bras, that's not natural. Instead of putting silicone
inside, you just put it outside."

Saturday, December 3, 2011

The skin on the eyelid is the thinnest in the body and distensible allowing the eyes to open and close at ease. If the skin is lost or poorly repaired as a result of trauma, the eyes may have difficulty in closing. This man was involved in a car accident in a rural area 6 weeks earlier. The laceration was repaired by an inexperienced medical officer who failed to appose the wound properly. This resulted in poor cosmesis and the patient was unable to shut his eye at night. The picture shows that the skin was sutured poorly to the lateral side of the upper lid resulting in shortage of skin in the middle part of the eyelid and the lateral side was bulky due to the excess skin.

To improve the appearance of the patient's eyelid and allow the eye to shut properly, reconstruction was undertaken as shown in the photographs below. The area of scarring was released and covered with skin flap taken from the lateral side of the upper lid.

The picture below was taken 2 months after the reconstruction showing much improved cosmesis and normal eyelid closure.

Monday, November 21, 2011

Medical tourism is big business in South East
Asia. It allows patients to combine medical treatment with holiday at very
affordable rates. Several countries have emerged as major medical tourist
destinations such as Thailand and Singapore. Provided the treatments are
performed by well-qualified doctors in established hospitals or clinics,
patients usually receive good and uncomplicated cares. Occasionally, the
language barrier and cultural difference can spring surprises for patients
especially when the patients were seeking aesthetic treatments.

Beauty can come in many forms but most people do not

want aesthetic procedures that make them drastically

different from members of their communities.

Even people from East Asia show differences in their

eyelid appearances. The native Thais (left and middle pictures)

tend to have higher skin creases than the Chinese.

This woman went to a neighboring country for
upper eyelid surgery. Post-operatively, she was very upset that the skin
creases were made too high and the eye appeared sunken. She complained to the
surgeon and was told by him her looks were what the women in his country
desired. If he were to make the skin creases too low or did not remove the fat
his patients would be upset !. It is important to discuss with the surgeon
beforehand the looks you desired and do not trust the
doctors to make the judgement for you especially if you have the operation done in
a different country. Remember thatbeauty comes in many forms and different cultures have different ideas
of beauty.

Tuesday, October 11, 2011

In patients who have excess upper eyelid skin (dermatochalasis), the amount of excess skin tends to be more on the lateral side. This can be caused by several factors but two of the main ones are loss of the lateral fat pad with age (leading to loss of support for the skin) and drooping of the eyebrows. During surgery, it is important to remove this lateral skin; otherwise these excess skin (known as lateral hooding) can make the patients appear old and sad. Patients who had had surgery performed in beauty centres or by less experienced surgeons often fail to have these problems addressed because the operators were concerned about leaving behind scars beyond the double eyelids. However, when done properly, these extended lines beyond the double eyelids usually resolve within a few weeks.

This middle-aged woman underwent upper eyelid surgery in another centre seven months ago. She was unhappy with the result because of lateral hooding. On examination, her eyebrows were at the normal position and therefore lifting the eyebrows is not appropriate in this case. She was offered two options: a. excision of the skin below the eyebrows to lift the excess skin; or b. remove the excess skin directly. She opted for the later option because the heights of the double eyelids are also asymmetrical. ﻿

﻿

Excess upper eyelid skin drooping over the lateral sides of

the eyelids (lateral hooding).

Patient also has unequal double eyelid heights.

Excision of the skin below the eyebrows can lift

the excess skin.

The excess skin can be removed by directly removing

the excess skin.

Extended upper eyelid blepharoplasty was performed together

with recreations of the upper eyelids .

The appearance of the eyes at one weeks, the scars beyond

the double eyelids have begun to fade.

The following pictures show another patient who underwent dermatochalasis (excess upper eyelid skin) operation using the extended upper blepharoplasty technique. The scars faded after 14 days.

As I study now to be an eye MD, I ask what kind of doc I want to be. It is a rather daunting question That raises fear and apprehension,

As each eye part has its own specialty!Should retina be the field in which I train To find a tear or subtle new membrane? But I seem to give my patients aches When I indent to find their breaks And that just makes for too much mental strain.

Perhaps it should be neuro-ophthalmology: The optic nerve, its path, and its pathology. But when there’s pallor, one asks Why? With CT, PET, and MRI … So why not just go into radiology?

My surgery could be limited to refractive. I’d soon build up a practice, very active. Though YAGs and excimers do magic The odd myopic surprise is tragic: On balance this may not be so attractive.

Then how about procedures oculoplastic On skin that is no longer so elastic? But operative hours are long (a pain), And patients they are, oh, so vain. It’s hard not to say something too sarcastic.Perhaps glaucoma is the field to choose, Though pressures, fields, and angles do confuse: Does pressure cause the nerves to die, Or sick nerves yield when pressure’s high? I’d like a field where fewer patients lose.

Strabismus is another possibility, To repair defects in the eye’s motility. But waiting rooms with children crying Would, in time, become quite trying (From residency right through to my senility).

With so much then to learn, is it reality To limit oneself to only one modality? The eye is wondrous and diverse! I think I’ll embrace, for better or worse,The field of ophthalmology in totality.

Although most of my private patients are concerned with double eyelids and eyebags; a large proportion of my patients seen in the Sarawak General Hospital are concerned with non-cosmetic eyelid conditions such as eyelid tumours and eyelid malpositions referred from all over Sarawak. A recent example is this patient who developed a right cicatricial ectropion (retraction of the eyelid as a result of scarring) after facial infection.

Thursday, September 15, 2011

Another important cause of unequal double eyelid height is due to unequal removal of the eyelid skin. This is especially common in older patients with excess skin, the eye where less skin is removed will result in the eyelid hanging over the double eyelid making the double eyelid appears lower.

The picture on the left shows equal amount of skin to be removed is marked whereas the picture on the left shows that the left upper eyelid has more skin being marked for removal.

This woman underwent a double eyelid surgery in a beauty saloon. Unfortunately, the left double eyelid appeared lower than the right (right picture). She went back to look for the "surgeon" but was told that she had returned to China without forwarding address or telephone. Examination showed that more skin had been removed in the right than the left eye. Revision was carried out by removing the excess left upper eyelid skin.

As mentioned in the previous blog double eyelid (skin crease) asymmetry is one of the most common complaints from the patients undergoing double eyelid surgery. Unequal skin markings before the operations is an important cause of the asymmetry and to avoid this:

a. It is important to mark the skin prior to any anaesthetic injections to avoid distortion of the tissue.

b. In addition, double eyelid surgery should be postponed if there is any eyelid swelling which again can distort the tissue for symmetrical markings.

c. During the markings, the measurement should be precise and ideally a caliper (as shown in the picture) should be used rather than a ruler.

d. Another important thing to remember during markings is to ensure that the skin of the eyelids are under equal tension (see pictures below).

Thursday, September 1, 2011

Several studies looking into the complications and patient dissatisfaction of double eyelid surgery found that unequal double eyelids (asymmetry of the skin creases) is one of the most common complaints (see references below). While unequal double eyelids are common immediately after double eyelid surgery, their persistence beyond 4 weeks should be regarded as permanent. Patients who have significant unequal double eyelids (more than 1 mm different) often seek help to address the imbalance.

This 38 year-old underwent double eyelid surgery in a beauty saloon using the suture technique. The procedure was performed by a "doctor" from China of dubious qualification. Post-operatively, she noticed significant unequal double eyelids. Despite repeated reassurance from the beauty saloon owner, the asymmetry remained 8-week post-operative. Unfortunately, the surgeon had since gone and could not be contacted.

The three possible causes of this
deformity noted were:

a.The difference in measuring and marking the skin for
suturing or incision

Saturday, August 27, 2011

One of the most common cause of dissatisfaction after double eyelid surgery (Asian blepharoplasty) is unequal height of the double eyelids (skin creases). However, even in the best of hands, the lines created are likely to be slightly unequal in height and provided the difference is slight most patients can be persuaded to accept the results. In fact, it is worth noting that amongst models and film stars who are perceived as attractive, asymmetry of skin creases are common (see pictures above).

In the next article, I will discuss the causes for unequal double eyelids after surgery and ways to restore the symmetry.

Tuesday, August 2, 2011

An eyelid without double eyelid may appear smaller because of the overhanging eyelid. (seewhy double eyelid makes the eye bigger?) If one eye has double eyelid and the other absent double eyelid, the later may be mistaken for droopy eyelid. I have come across a few patients who were referred to me for droopy eyelid when in fact the problem is absent of double eyelid in the smaller eye and the treatment of choice is to create a double eyelid. There are several ways of doing these either with non-surgical method (glue or tape) or surgery (both suture technique or incision technique).

Right eye appears to have droopy eyelid due to poorly

formed double eyelid. Creation of double eyelid balances

both eyelids.

Right eye appears droopy due to absent double eyelid.

When the double eyelid is created with tape the two

eyes appear the same size.

Below is the article which I recently published in Malaysian Journal of Medicine highlighting this condition:

About Me

I am an eye surgeon who also specializes in eyeid surgery. I was trained in Oxford Eye Hospital from 1997 till 2001. I am now a Professor in Ophthalmology in UNIMAS Medical School. Apart from this blogspot, I manage two othe sites Success in MRCOphth and Sarawak Eye Care.